Sugammadex and ideal body weight in bariatric surgery

Maria Sanfilippo, Francesco Alessandri, Ahmed Abdelgawwad Wefki Abdelgawwad Shousha, Antonio Sabba, Alessandra Cutolo, Maria Sanfilippo, Francesco Alessandri, Ahmed Abdelgawwad Wefki Abdelgawwad Shousha, Antonio Sabba, Alessandra Cutolo

Abstract

Background. The obese patients have differences in body composition, drug distribution, and metabolism. Sugammadex at T 2 recovery in a dose of 2 mg kg(-1) of real body weight (RBW) can completely reverse the NMB block; in our study we investigated the safety and efficacy of Sugammadex dose based on their ideal body weight (IBW). Methods. 40 patients of both sexes undergoing laparoscopic bariatric surgery were enrolled divided into 2 groups according to the dose of Sugammadex: the first received a dose of 2 mg kg(-1) of IBW and the second received a dose of 2 mg kg(-1) of RBW. Both were anesthetized with doses calculated according to the IBW: fentanyl 2 μ g kg(-1), propofol 3 mg kg(-1), rocuronium 0,6 mg kg(-1), oxygen, air, and desflurane (6-8%). Maintenance doses of rocuronium were 1/4 of the intubation dose. Sugammadex was administrated at T 2 recovery. Results. The durations of intubation and maintenance doses of rocuronium were similar in both groups. In IBW group, the T 4/T 1 value of 0.9 was reached in 151 ± 44 seconds and in 121 ± 55 seconds in RBW group (P = 0.07). Discussion. Recovery times to T 4/T 1 of 0.9 are surprisingly similar in both groups without observing any postoperative residual curarization. Conclusion. Sugammadex doses calculated according to the IBW are certainly safe for a rapid recovery and absence of PORC.

Figures

Figure 1
Figure 1
T4/T1 recovery (sec) after bolus dose of Sugammadex in groups IBW (A) and RBW (B).

References

    1. Adam JM, Bennett DJ, Borm A, et al. Cyclodextrin-derived host molecules as reversal agents for the neuromuscular blocked rocuronium bromide: synthesis and structure-activity relationships. Journal of Medicinal Chemistry. 2002;45(9):1806–1816.
    1. Naguib M. Sugammadex: another milestone in clinical neuromuscular pharmacology. Anesthesia and Analgesia. 2007;104(3):575–581.
    1. Bom A, Bradley M, Cameron K, et al. A novel concept of reversing neuromuscular block: chemical encapsulation of rocuronium bromide by a cyclodextrin-based synthetic host. Angewandte Chemie—International Edition. 2002;41(2):266–270.
    1. Bridion. (Sugammadex) Summary of Product Characteristics available via the electronic Medicines Compendium, 2009.
    1. Yang LPH, Keam SJ. Sugammadex: a review of its use in anaesthetic practice. Drugs. 2009;69(7):919–942.
    1. Fuchs-Buder T, Claudius C, Skovgaard LT, Eriksson LI, Mirakhur RK, Viby-Mogensen J. Good clinical research practice in pharmacodynamic studies of neuromuscular blocking agents II: the Stockholm revision. Acta Anaesthesiologica Scandinavica. 2007;51(7):789–808.
    1. Balsiger BM, Murr MM, Poggio JL, Sarr MG. Bariatric surgery: surgery for weight control in patients with morbid obesity. Medical Clinics of North America. 2000;84(2):477–489.
    1. Leykin Y, Pellis T, Lucca M, Lomangino G, Marzano B, Gullo A. The pharmacodynamic effects of rocuronium when dosed according to real body weight or ideal body weight in morbidly obese patients. Anesthesia and Analgesia. 2004;99(4):1086–1089.
    1. Stokholm KH, Brochner-Mortensen J, Hoilund-Carlsen PF. Increased glomerular filtration rate and adrenocortical function in obese women. International Journal of Obesity. 1980;4(1):57–63.
    1. Abernethy DR, Greenblatt DJ. Pharmacokinetics of drugs in obesity. Clinical Pharmacokinetics. 1982;7(2):108–124.
    1. Abernethy DR, Greenblatt DJ, Divoll M. Alterations in drug distribution and clearance due to obesity. Journal of Pharmacology and Experimental Therapeutics. 1981;217(3):681–685.
    1. Abernethy DR, Greenblatt DJ, Divoll M, Shader RI. Enhanced glucuronide conjugation of drugs in obesity: studies of lorazepam, oxazepam, and acetaminophen. Journal of Laboratory and Clinical Medicine. 1983;101(6):873–880.
    1. Cheymol G. Clinical pharmacokinetics of drugs in obesity—an update. Clinical Pharmacokinetics. 1993;25(2):103–114.
    1. Nigrovic V, Banoub M. Onset of the nondepolarizing neuromuscular block in humans: quantitative aspects. Anesthesia and Analgesia. 1993;76(1):85–91.
    1. Naguib M, Kopman AF. Low dose rocuronium for tracheal intubation. Middle East Journal of Anesthesiology. 2003;17:193–204.
    1. Banoub A, Migrovic V. The apparent space of interaction of muscle relaxants with post-synaptic nicotine receptors: implication for the onset of neuromuscular block. Anesthesia and Analgesia. 1994;787, article S18
    1. Ingrande J, Lemmens HJM. Dose adjustment of anaesthetics in the morbidly obese. The British Journal of Anaesthesia. 2010;105(supplement 1):i16–i23.
    1. de Boer HD, Driessen JJ, Marcus MAE, Kerkkamp H, Heeringa M, Klimek M. Reversal of rocuronium-induced (1.2 mg/kg) profound neuromuscular block by sugammadex: a multicenter, dose-finding and safety study. Anesthesiology. 2007;107(2):239–244.
    1. Epemolu O, Bom A, Hope F, Mason R. Reversal of neuromuscular blockade and simultaneous increase in plasma rocuronium concentration after the intravenous infusion of the novel reversal agent Org 25969. Anesthesiology. 2003;99(3):632–637.
    1. Groudine SB, Soto R, Lien C, Drover D, Roberts K. A randomized, dose-finding, phase II study of the selective relaxant binding drug, sugammadex, capable of safely reversing profound rocuronium-induced neuromuscular block. Anesthesia and Analgesia. 2007;104(3):555–562.
    1. Sorgenfrei IF, Norrild K, Larsen PB, et al. Reversal of rocuronium-induced neuromuscular block by the selective relaxant binding agent sugammadex: a dose-finding and safety study. Anesthesiology. 2006;104(4):667–674.
    1. Mirakhur RK. Sugammadex in clinical practice. Anaesthesia. 2009;64(1):45–54.
    1. Eleveld DJ, Kuizenga K, Proost JH, Wierda JMKH. A temporary decrease in twitch response during reversal of rocuronium-induced muscle relaxation with a small dose of sugammadex. Anesthesia and Analgesia. 2007;104(3):582–584.
    1. Drobnik L, Sparr HJ, Thörn S, et al. A randomized simultaneous comparison of acceleromyography with a peripheral nerve stimulator for assessing reversal of rocuronium-induced neuromuscular blockade with sugammadex. European Journal of Anaesthesiology. 2010;27(10):866–873.
    1. McDonagh DL, Benedict PE, Kovac AL, et al. Efficacy, safety, and pharmacokinetics of sugammadex for the reversal of rocuronium-induced neuromuscular blockade in elderly patients. Anesthesiology. 2011;114(2):318–329.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe